and hospitalists are her expertise on interim public health director for Williamson County, Tennessee. Recently, Dr. Collins returned to her hometown of Houston, Texas to assume a faculty position as an assistant professor at Sam Houston State University College of Osteopathic Medicine. At the university, she serves as course director for clinical medicine for chairperson of the admissions committee, a member of academic leadership council and co-facilitator for the Texas Joint Admissions Medical Program. Beyond her academic and clinical roles, Dr. Collins is deeply engaged in community service and advocacy. She serves on the International Health Commission of a large faith-based organization where she previously chaired the collaboration between the organization and the Alzheimer's Association. This initiative aims to enhance access to community resources, dementia care, and research for persons and families dealing with the many aspects of the disease. Dr. Collins remains active in the mission to educate communities and healthcare professionals regarding Alzheimer's disease and other dimensions. At this time, please let us welcome Dr. Collins. Okay, so thank you so much for having me. I appreciate the opportunity to speak with you all and special thanks to my immediate boss, Dr. Sanderlin, for letting me know about this opportunity. So today we're going to talk about an illness and a disease that all of us are familiar with. I always take a poll and ask people to raise your hand if you don't know of anyone that has Alzheimer's disease. I'll wait. So, scanning the room, generally everyone knows someone that has Alzheimer's disease or especially some other dementia, or they know someone who is taking care of someone who has Alzheimer's disease or some other dementia. So this is a very common topic, but there's a lot with it in different ways that we can approach it and think about it. So today we're going to talk about really the epidemiology of this being a generational concern. We do have several objectives and our objectives hopefully will enhance your knowledge of Alzheimer's disease and its generational effects on families, finance, and function. And also that you'll be more equipped because I'm certain that you are equipped to have some of those difficult conversations with family members, some of your friends, and patients' families regarding dementia. All of these objectives are going to require compassion when speaking with persons, because when you start speaking about dementia, it sometimes incites fear, anger, denial, and sometimes depression. And it also, at some points, when people initially start speaking about it, they may stop, they may put up a blockade and not want to progress. And early intervention is very important. So keeping that in mind is really important. So we know that epidemiology is the study of the distribution and determinants of health-related states or events and in specified populations. So Alzheimer's disease, we're generally thinking of persons over 65, but when we started looking at that generational effect, it's everyone. Because it can have an effect on everyone in the family, everyone in the community. And we use this information to help us manage patients and help us to manage the disease. But we also have to use this information to help to manage the expectations of family members, expectations of the community and what community resources are and where they should be presented. This information becomes important because there are places, and there are some states that are labeled dementia specialist deserts, meaning they really don't have the resources available for persons with this illness, or they don't have the specialists there. And so in this school, we look at rural communities and those types of things. So if it's already difficult for you to have a primary care physician, how difficult do you think it's going to be to have someone that is going to be a specialist in Alzheimer's disease, dementia, and then actually have the resources in that area for that family? So what is Alzheimer's disease? We know that it is a neurocognitive or neurodegenerative illness that interferes with a person's daily life to remember, recall, relate, or imagine. And that becomes important, especially when you start thinking the caregivers and educating patients and communities, because sometimes they can't understand. I don't understand why mom doesn't understand. I'm taking care of her. I'm taking care of the kids. I'm going to work. I have all of these other things. And so you have to remind them. They can't relate. It's not that they don't want to relate. They simply can't. And they simply can't remember. And so being able to manage the expectations of the family becomes really important. And so we know there are hallmarks or biomarkers of Alzheimer's disease that include beta amyloid plaques, neurofibrillary tangles, and neurodegenerations, and that it is a chronic disease for which there is no cure. That all sounds great. And at the top, we see a picture of the healthy neuron. There's nothing there. And inside, they're able to communicate between each other and give out information. But at the bottom, we start seeing plaque formation. And you have the neurofibrillary tangles with inside the neuron or the top protein. And you have this neurodegeneration. So we're all scientists here. So you understood all of that. But if you start sharing that with the family, it may kind of go over their heads. So what do we do? How do we explain this to them? Generally, pictures are worth a thousand words. So I generally go and say, you know, the brain is compact. It's a compact organ, and it has some weight to it. And so you have this normal brain. And at the top of the brain, the covering of the cortex, this is the area that helps with thinking, planning, and remembering. But as we get with Alzheimer's disease and those plaques build up, and those tangles, and the information isn't able to be distributed, it kind of starts breaking down. And so this is why they can't really plan the family reunion, and they've been doing it for forever, or remember all the information. And sometimes they're like, she can remember everything from 20 years ago, or he can remember everything from when he was in the military flying jets, but they can't remember what I told them two minutes ago. And so you're able to show, well, this is the hippocampus. And as that breaks down, they're not able to form those new memories, right? So the short-term memory is there, and you have to explain those things, and that there's a difference between dementia and normal aging. And just because you're aging doesn't mean that you're gonna get dementia, right? We have any questions so far? Okay. And so the other picture that I show is this one. Shows a nice, yes. There is a dementia of aging, though. Are they normal? So generally dementia we use as a umbrella term. And so yes, there are different things that can occur based on some of your comorbidities and what can go on, and you can have a mixed dementia, which can be very close. A lot of them, a lot of dementias can be very close, and you can have a mix. But when we start talking about aging, because of course, the older you get, once you get to be about 80 years old, they're gonna be about 33% of persons 80 and over with Alzheimer's disease. Can they have some other dementia once you become that age, neurovascular dementia is more prevalent at that time. And so this picture, I like to show patients because we've talked about the compact brain and then they are able to see it. So what I generally ask for physicians to do is to make sure that you have that information there that you're able to show so that they can kind of visualize because a lot of times now, especially with EMRs, people have access to their records, right? And they're gonna review the CT scan and all of this, and it's gonna say, you know, there's brain atrophy or this going on, and they don't, you know, not having a medical background, can't really visualize or understand what that means. And so we wanna do that as part of the education process. So again, we have biomarkers, the beta amyloid proteins, tau proteins, and then neurodegeneration. So you oftentimes will see ATN as some of the hallmarks, and we're able now to look at cerebral spinal fluid and sometimes with a PET scan to look at those levels and to start looking at those a little bit earlier. Persons that have the genetic mutation of dominantly inherited Alzheimer's disease can be asymptomatic for even up to 22 years before they start showing symptoms, but their levels of the biomarkers have gone up. And so that's really kind of a benefit for everyone now that we're having more ways to identify the biomarkers and their elevation, because even if you don't have the genetic mutation, oftentimes the biomarkers are elevating prior to you having any symptoms. And so again, early intervention is becoming important, and this definitely helps with research and with researching some of the newer meds and some of the other things that may be down the pipeline. So with dementia, like I said, it's an umbrella term. There are several types, but for Alzheimer's disease, you know that it is the most common type of dementia with three major risk factors, and that's age, genetics, and family history. So when I made this slide, which was last week, there were 6 million Americans that were living with Alzheimer's disease, and that's our 2023 information. The 2024 information came out two days ago. So now there are 7 million. 2023, six, 2024, we're at 7 million persons that are living with Alzheimer's disease. So essentially one in three seniors dies from Alzheimer's disease. At age 45, the risk is about one in five for women and a little less for men. But age alone isn't the only cause, and that sometimes becomes the idea with laypersons. They think when you get older, it's all gonna be Alzheimer's disease, and it's not, and being able to differentiate the different types of dementia and that you can actually have a combination dementia. So when we start going through this, I always like talking about the 10 warning signs when you're educating families, because it does help us to separate what's normal aging and what's not. So memory loss that disrupts daily life, that's important. We all forget things. I have a habit of forgetting my keys, right? Anybody forgot their keys, couldn't find their glasses, and they were sitting on top of their head. I don't know where my cell phone is, but I'm talking on the phone with someone and telling them where it is. We all forget. If you have a teenager, did you do your homework? I forgot. That's normal, that happens. It's not great. It may interrupt you, it may be an annoyance, but it's really not disrupting everyday life, right? It's really situational. And so when we start thinking about memory loss, we're looking at it disrupting daily life. Yes, as you get older, sometimes, you know, it takes you a little longer to remember some things or the process, but it's not disrupting your daily life. Like I told you earlier, I lose my keys. So if I lost my keys today, what would I do? You lost your keys, what do you do? You backtrack, you ask Rhonda. But you knew to go ask Rhonda, right? You are able to formulate a plan to find your keys. But I know that I drove here, right? So I would think that my keys would be with me. I know that when I came in the building, I didn't come through the front door. I would think that my keys would be with me. I have to unlock my office. My keys should be with me. So if, and then I came over here, right? My keys should be with me. And if you look on the back table where I was sitting, my keys are there. I'm able to retrace my steps. And that becomes important because that takes a lot of cognition. We do it without thinking about it. We do it all the time and we're able to process it. We don't make a big announcement about it. We just go and do it. But when you have Alzheimer's disease or dementia, that becomes more difficult. And eventually you will lose your ability to do that. Right? And then number nine, the withdrawal from social events. Remember at the beginning, I said, sometimes when you start bringing up Alzheimer's disease or dementia with patients or families, there's some denial and sometimes they start blocking things out. Sometimes people know that they are going through some of this, but I don't want everyone else to know yet. So I'm gonna start excluding myself from events and not going through my normal routine and not participating in things that I've already done. And then that brings on more depression and isolation and a lot of times a delay in treatment. So we start having to look at this from a larger perspective when we think about normal aging and the warning signs with Alzheimer's disease. Again, we talked about family history and that if you have a family member that especially a first degree relative with Alzheimer's disease, you're at an increased risk. But we also have to share with patients and family and friends that it's not a requirement because sometimes people are like, oh, everybody lived to a hundred and they never had any problem. No one in my family has ever had that. It's not a requirement. It may increase your risk, but it really is not a requirement. Sometimes grandpa can't remember and he gets really sad. And so Kelly shared this with us and was age six. So Kelly and grandpa had a routine. You know, and every Thursday, grandpa takes Kelly to school because Kelly's parents work. And on Thursdays, they had to be there earlier. So they dropped Kelly off with grandpa. Grandpa takes Kelly to school. It was shared with me that Kelly and grandpa had a really great morning routine where they had a special breakfast every Thursday. So I was like, oh wow, what was the breakfast? And I was thinking, you know, grandpa made some special pancakes or his scrambled eggs were really good. Would anyone like to guess what the special breakfast was? Ice cream. You're exactly right. So I'm thinking like, oh, the special breakfast. And literally the parent that was there was not too excited, but it was ice cream. They have Blue Bell ice cream every Thursday morning for breakfast. That was their special thing. And then they had a whole bowl and all of that. And so like a lot of grandparents that live close by, grandpa sometimes had to go pick Kelly up from school and they would go on adventures or what they said. And oh, Kelly, we're just on an adventure. We're turning corners, we're going places. And so they would go on their adventures when they were picked up. But one of their adventures didn't go so well. Grandpa forgot which corner and couldn't remember which corner to turn to go back home. It started getting a little later. Of course, you know, Kelly is getting hungry. They're both getting a little irritable and eventually they both end up in the emergency room because sometimes grandpa can't remember and gets really sad. And with that, on that day became a lot of frustration. Wherever they ended up, you know, the ambulance was called to bring them in. And so when we start looking at how this can affect families you find that, you know, 11.3 million children under the age of five have working parents, if they're five and under about 3.3 million or 30% of children are going to be cared by their grandparents during that time. And if they're a little older school age, about 4.7 million will be cared by their grandparents either before school or after school. That's not uncommon, especially if the grandparents live within an hour of the family, but that can create some issues and the young kids or the children may be some of the first to notice because the parents a lot of times are dropping off or picking up. They're not there to know that we turn corners or that sometimes grandpa gets sad or frustrated because really he can't get home. And the information comes out when there's an event. So you have, again, approximately 40% of grandparents that live within the hours drive of the children and they provide care to kids under 13. And if they're under six, 64% of those grandparents are involved. So when we start looking at Kelly and his grandfather and their bond together, who's gonna let grandpa pick Kelly up on Thursday, next Thursday or from school? And so that dynamic begins to change. And then if you're 13 or older, the dynamic is gonna change. Grandpa was taking care of you. Now you're kind of coming over to grandpa's house, however you get there to kind of check on him. So where you were being cared for, now sometimes you're brought into a caregiver role, even at a young age. Some of this is discussing grandparents in the household, but the one that I would like for you to focus on is no parent present. A lot of times when you start thinking about children that are being raised by grandparents and their parent isn't present, we have the, sometimes our bias shows and we start thinking, oh, the parent must be on drugs or it's a deadbeat parent. They're irresponsible. But some of the other reasons why children may be with parents is because the parent is sick or dead. I know a grandparent who is raising two kids. They were retired. She and her husband, her husband ended up dying from cancer and her daughter and her son-in-law got in a car accident and they both died and left two children. So the children are being raised. In the news, we've been hearing about the royal family and sometimes children are raised because their parents died from illness or cancer or something like that, or the grandparents have to become more involved or they move into the home with the parent, the parent that's still living to help raise the child. So those are other things that we have to think about. And when that occurs, you have to start having discussions again with families because what happens if that grandparent gets dementia and they're the sole provider or caregiver of the kids? And even if people have dementia and that comes up, that early, you want to initiate those discussions of who will be your power of attorney for healthcare? What are your things? Where are your deeds, your mortgages, your insurance policies? And those are conversations that need to be had. And especially when you start looking at this group. So what happens when grandpa can't remember? Who's going to take care of him? Remember the parents need some help taking care of Kelly. So now who's going to take care of Kelly and grandpa? Who cares for the grandchildren while they're at work? How much does all of this cost? Or what is going to be the increased cost on the family? How will this affect the family dynamics? How can the family get help? And who's going to tell grandpa that he can't pick Kelly up anymore? Who's the person and who's going to tell Kelly that grandpa isn't going to pick him up anymore? Those are some difficult conversations. And oftentimes it can be a battle. You think I'm going to hurt him? I just got a little thrown off. I know how to get home, all of this stuff. And so sometimes that's when we can step in as a physician and take the brunt of that. I as the doctor am going to tell you that you can't drive, I'm concerned. Because if he's grandpa's mad at me, I'm not going home with him, right? So his being mad at me is going to be okay. That's not going to be an ongoing fight at home about who said, or you don't want me. They can always refer it back. Well, your doctor said that right now you shouldn't drive and that we need to find another way for Kelly to get to school and to get home on Thursdays. So what's the cost? It's a lot. So in 2029, which is what about five years from now, 78 million baby boomers and 10 million generation X are predicted to have Alzheimer's disease. Remember just last year, it was 6 million. Now at 2024, we're at 7 million with a total health cost of at least $172 billion. And so when we start looking at that and when we start looking at patient costs, skilled care, 6K per month, in-home care, daycare, that's not counting the 40 billion hours of unpaid labor from family members and other persons who are just there to help and assist. They're not getting any compensation from that. And when we start looking at that they're 6 million, six to 7 million people with Alzheimer's disease, it is currently taking 11 million people to provide care. And that's just within the family and the community, we're not going into to all of it, everyone else. So that's at least two persons per person, almost two persons per person to provide daily care for someone with this illness. And the cost goes up. Remember this is a progressive chronic illness. And as it progresses, the more resources you need and so the cost then goes up. I can tell you that skilled care number is probably low. Oh yeah. He's saying the skilled care number is probably low. And yes, it is. And a lot of things, skilled care, daycare and all of that will be determined where you live, your type of insurance and also your age. Because if you are, the average age, remember generally 65 and older, but what if you're under 60? Because your insurance and resources for Alzheimer's disease doesn't really kick in until you're 60 years old. And so those persons who are diagnosed, even if it's severe and they're not 60, those resources are generally not available. And that's a hard pill to swallow. I had a patient who, you know, I work with Alzheimer's and research and all of this and I'm a hospitalist and they are in and the social worker case manager was very involved in the local Alzheimer's organizations and research and community service. And we could not, there were no resources for this patient because he wasn't 60 years old. Had excellent insurance and benefits, had family support, but again, you know, wife and everyone is still working. Kids are in college or, you know, off. So that was a hard thing to manage and to understand, but, and that's something to keep in mind. If you're not 60, then those resources may not be there. And so here's some numbers for assisted living, nursing home rooms and private rooms. So, you know, everyone doesn't have $115,000 a year addition to put out. So things that concern the caregivers, there are two major things that 70% of caregivers have concerns about. Does anyone know? Two major things. We've talked about one, one is cost. And the second is the coordination of care. Cost and the coordination of care. And so the cost can be extremely high. The coordination of care, again, if you don't, you know, haven't done this and managing the healthcare system can become a problem, that's, that becomes a big issue. So how do we go about helping? Yes. I just wanted to make one comment about your last one. If you're not 60 yet, my mom lived to 105 and she had good insurance, but trying to keep her in the home and she had a vascular, neurovascular. So, but trying to keep her in the home, I thought I was fairly intelligent, but every resource I'd try to find, she wasn't eligible for. So it's not just those less than 60, it's very expensive to care for your people. Because a lot of the resources just become unavailable. They do. Thank you for sharing that. That is true. And again, where you live makes a big difference. In July of this year, Medicare and Medicaid are trying to release a program that will try to assist with coordinating care. To help and assist. And that is supposed to start occurring in July of 2024. It becomes difficult to do that because as this progresses, it may be more difficult to get the patient to, you know, we've got to go, they may not want to go and the resistance and all of the other things that come with this. Fortunately now, sometimes we can avoid, sometimes some of this by using telemedicine and those types of things. But we start having to think about that. How do we coordinate this? And how do we make adjustments for that? You know, a lot of practices have a rule, you know, you miss so many appointments or you're late for so many appointments, you could be dismissed from the practice. But we are gonna have to start taking into effect those things that may be stopping those persons from being able to get to those appointments on time and maybe having a little bit more liberal schedule to accommodate that. And some of the other things that we have to start, how do they remain present for other members of their family? Remember Kelly's six. So Kelly still may want to go play T-ball or basketball or whatever, be involved in activities. How do they remain present for their spouse, their children? And we've talked a little bit about how we can help and assist, but we have to have the information on hand so that when that occurs, that we're going to be able to give them assistance or information for your area. So what do we do about all of this? We educate and education is really gonna be key, especially when you're speaking with families. And the other thing is people are gonna ask you about Alzheimer's disease and other things, just because you're a physician. We all know that they could care less about your specialty. They're gonna ask, you're a doctor, what is this? And so with that, the biggest thing is letting them know that this is a chronic illness and that it is progressive and that your family member is going to get worse, but that we can slow down this progression with early intervention. And so letting them know that the medicine is not gonna make them go back to quote normal, because there are families that will stop giving the medicine because they say, well, it's not working. That's not how it works. They're here, we want them to keep here and they're eventually gonna go here, but we want it to be a long, slow process that they stay at their best or their maximum capabilities for the longest period of time. And so with research, of course, there are things that are coming in. There are new medications that were FDA approved this year, but that's only for early Alzheimer's and it's IV infusions every two weeks. And you have to have a baseline MRI and serial MRIs. And guess what? Serial MRIs probably are not free. So we're thinking about money. Infusions and infusion centers are generally not gonna do it for free. So there here we are again with costs and there's also risk, risk of swelling, head swelling, there's risk of bleeds and those types of things. But hopefully, the more research that we do, the more that we participate in research, the better things should be and that hopefully we'll be able to end Alzheimer's and other dementias. Support, not only for the patient, but support for the caregiver is important as well. Sometimes your patient is not the person with Alzheimer's disease. Sometimes your patient is the family member or the caregiver. And third, for the caregiver, the third biggest concern for caregivers out from costs and coordinating care is their own personal health and mental health. Because sometimes as this progresses, they're limited with social activity and they're watching this decline of a loved one. And so we want to be able to support them and we also want to encourage people. When your friend comes and tells you, oh, I think this is happening to my family member, that we continue to encourage them to see their physician, get the referral if necessary, but start early intervention to slow the progression of this disease. So thank you again for having me. If you have anyone with any questions, I'm happy to answer them. Thank you. Thank you. You mentioned a couple of times, I have the mic, I have the mic, I'm talking into the mic. They want to take the mic. You mentioned a couple of times imaging and for a long time, we always said that, for example, you can't positively know like Lewy bodies until you do an autopsy, et cetera. But as we're getting better with functional MRI and spec and all these more detailed and high level scans and whatnot, how far are we removed from actually being able to diagnose, not just clinically, because if you see four different neurologists, you get six different diagnosis and they stick to a favorite diagnosis regardless. So how far are we away from really getting significant findings on imaging and that you could definitively diagnose and also monitor the progression of the disease? So I think there are two questions. Are we close to be able to do the diagnosis with some radiographic findings? And then the second, how close are we to monitoring? The first question, we are very close and it's actually, when you go to the research conferences, it's available, it's expensive and it's just really not routinely done. So that's where we are with that. So far as monitoring, until we can control the expense and start looking at this and even when we are getting the biomarkers from the cerebral spinal fluid and all of that, all of those things aren't routinely done, but we can monitor them. It's becoming more available and then in studies and that's why we try to encourage people to participate in Alzheimer's research and the different studies so that we can get there. Because a lot of things, I think when we start looking at prevention is going to be, can we find these biomarkers? And like you say, look at them to see if they're going up or how much they're going up in persons. So I'm gonna ask the same question but backing out even further. You talked a lot about Alzheimer's and certainly the social cost and the difficulty of the disease. What definition are you using of Alzheimer's? Is it dementia without another diagnosis or something else? So dementia, like I said, is the umbrella term. Alzheimer's is a type of dementia. Most persons, and I'm speaking with this as Alzheimer's by itself, but a lot of people with Alzheimer's disease or even some other dementias, a lot of times there's a mixed dementia, especially once you get over 80, it's generally gonna be a little vascular dementia as well as Alzheimer's disease. But what I'm trying to say is, so basically it's just Alzheimer's, the way you're talking about Alzheimer's is everybody with dementia that doesn't have another diagnosis. Is that correct? I'm sorry, say that again. Everybody with dementia that doesn't have another very specific diagnosis for another different dementia. Because it seems like it's mostly a clinical diagnosis with no testing as of right now to really confirm it. Would that be, am I in the right place or am I missing something? Yeah, I kind of think you're missing a little bit. There are ways that we can go. And so a lot of times we send it to a neurologist, but you can also rule out some other things. But keeping in mind that most people, a lot of people will have a mixed dementia. It's not necessarily gonna be frontal temporal, but if we're looking at Alzheimer's disease, vascular is gonna be there. Because the other part of Alzheimer's disease is controlling your other comorbidities, especially hypertension, diabetes, those things that can cause a vascular problem. And also looking at coronary artery disease and those things, because what's good for the brain is good for the heart or what's good for the heart is good for the brain. So I won't always think that this is the only thing, but generally this may be the primary diagnosis. And yes, you can have a secondary diagnosis. Yes. Yes, what's, I think I'm on. Yes. What's your thought of work, some of the preliminary work of Dale Bredesen and using, and Chris Palmer at Harvard who are trying to use, they're basically calling dementia type three diabetes of the brain essentially, and using lower refined carbohydrate diets and plant food diets to help slow or reverse Alzheimer's. Thoughts on that? So I don't know that I like the term type three diabetes, but I do agree again about diet and looking at a diet that, a heart healthy diet and a diet that works with carbohydrates and decreasing your risk of having other comorbidities that can feed into this. So I do agree with that and making that as part of our preventative measures, as well as there's research that's saying that if you walk at least 4,000 steps a day may decrease your risk of Alzheimer's. The more you socialize can decrease. And so I think bringing all of those things into play is going to be important because our incidence is going to go up because we are living longer, right? And so I think all of that coming into play is important. My only thing is I just don't like that term, but other than that, I agree. Yes, sir. Ma'am, thank you so much earlier for yielding me a little bit of your time. I really did appreciate it. I have had several patients come back and ask for like re-referral to the geri psych that we have on the base who initially like did the in-depth diagnosis for dementia for them, like years, several years down the line, like they want to go back and see them again to get diagnosed again. Is that appropriate? Or like what part of like reassessment in terms of like outside just doing like a mocha in clinic or something like that plays in the whole disease process? I think depending on, again, if they've had some other issue, if they've had a stroke, if there's some other changes that have come up, then that would be important. I think seeing geri psych is not a bad idea because again, a lot of people, like Kelly said, grandpa gets sad because he can't remember. And they're not necessarily at the point where they don't know that they don't have this illness. I often bring up, I have had an aunt who was actually a cousin, but a lot older, that was a retired nurse. And so when she got her diagnosis early on, she sat me down to quote, have a conversation with me about it. And she was like, you know, I have Alzheimer's disease, right? Yes, ma'am. This isn't gonna get better. You understand that? Yes. And so she sat and said, listen, I may start acting up. Please don't let me be out here acting crazy or running in the middle of the street and you not come and get me. So, and there was a depression component that was there, you know, that she went to geri psych or PCP to address because she knew that she was depressed and her depression was because she knew she had Alzheimer's and she knew that, you know, from our medical training that this was not gonna get better and the concerns with, you know, with family and what was gonna happen there. So it's not a, I don't find that a bad thing, especially if it is, if they've had it for an extended period. And again, sometimes there are other things that come in with this diagnosis that may need to be addressed with psych that I think is important. So that's not a bad thing. And then also, again, educating the family on the progression of the disease because they can get to a certain state where they're thinking this isn't working, they're a whole lot worse. I don't believe this diagnosis, something else may be wrong and then push to go again. And I would let them do that. Just quickly, one of your slides and I can't remember the number. And after your presentation, I'm scared that I can't remember the number. But I have found your car keys. I believe you said in 2029, 78 million are projected to be afflicted. And you said that right now we're at 7 million. We're at about 7 million. So that sounds like it has the capacity to really overwhelm the insurance industry. And so for those of us that might have a genetic predisposition, should I be trying to bank up resources or deplete my resources? So what we generally recommend is that you go talk to your estate attorney. And that seriously, those are some of the resources to discuss all of that prior to or with early diagnosis. So that all of those things can be in place. This number is also gonna go up because hopefully we are going to diagnose people earlier. And so that comes into play. But I would, that is something we recommend is that you discuss, talk with your estate attorney and to make sure all of that is in order and in place. Because some people, depending on where you are, if you give certain assets to family members, they would need to have those assets for two years prior to, so that they couldn't be utilized for care. That's another thing. All right. Thank you so much.

Alzheimer's advocacy

dementia care

early diagnosis

caregiver support

clinical medicine

community education

diagnostic technologies

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